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Intracranial Angiography

I. The Diagnosis of Vascular Lesions

Carl F. List and Fred J. Hodges

is used at 20 MA and 75 KV; for anteroposterior projection, exposure time is increased to 3 seconds and kilovoltage to 85. OBSERVATIONS Thirty-five cases of vascular intracranial lesions have been studied by this method. Our observations will be divided into the following groups: (1) Vascular occlusions and coarctation (2) Intracranial aneurysms (3) Arteriovenous fistulas (4) Congenital arteriovenous malformations 1. VASCULAR OCCLUSIONS AND COARCTATION In massive vascular lesions of the brain, angiography is an

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Intramedullary Arteriovenous Aneurysm of the Spinal Cord

Case Report with Operative Removal from the Conus Medullaris

William Beecher Scoville

interchangeably in descriptions of arteriovenous malformations. CASE REPORT J.V.W., a 14-year-old boy, was admitted July 1941 to the Hartford Hospital on the orthopedic service of Dr. Sidney McPherson because of progressive low back pain radiating down both posterior thighs, which had been present over a 3-year period, and was accompanied by occasional difficulty with micturition and more recently by diffuse weaknesss of his legs. Examination was essentially negative except for diminished left knee and ankle jerks, fibrillary twitchings in his posterior thighs and

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Joseph A. Epstein, Aaron J. Beller and Ira Cohen

lesion was confirmed. On a symptomatic basis and by examination, it is impossible to differentiate the arterial anomalies from the venous and arteriovenous malformations. The same fluctuation in symptoms, the varying sensory levels and the evidence of intramedullary and extramedullary cord disease with root compression may exist in all. The absence of cutaneous vascular naevi in the present group can be of little assistance in the differentiation of the arterial malformations from the others, although its occurrence in association with the venous, the arteriovenous

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Rupert Raney, Aidan A. Raney and J. M. Sanchez-Perez

of clarity in the films. These films, while satisfactory for clinical purposes, have not photographed clearly and have therefore been reproduced by drawings from the original films. The following cases serve to illustrate some of the short-circuit principles under discussion. REPORT OF CASES Case 1. Arteriovenous malformation distal to carotid siphon. Good collateral circulation through circle of Willis demonstrated by angiography. Circulation time delayed . J. D., 0-660, a man of 35 years, was examined in May, 1941, because of syncopal episodes for 7

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George G. Culbreth, A. Earl Walker and Robert W. Curry

vascular pattern of a meningioma. Although only the arterial pattern of the brain is demonstrated, the capillary pattern of the tumor is seen as a uniform opacity. B. ( R. S. ) A lateral angiogram of sphenoidal ridge meningioma which resembles a glioblastoma. As expected from the pathological anatomy of these angiomas, 6 angiomas of the arteriovenous malformations of the brain demonstrate enormous channels and sinuses fed by abnormally large, tortuous arteries and drained by hugely dilated veins. The arteries supplying the area are both more numerous and of

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Harvey Gass, Sydney Weinberg, Albert Craig, John J. Thompson and Frank Dreisinger

occurred, as in an arteriovenous malformation, we have been unable thus far to adequately visualize the venous phase of the injection consistently. Figs. 2 , 3 , 4 and 5 show a few frames in different phases in each of four different angiograms. Progression of the dye from one frame to the next is not recognizable in still pictures but can be made out from one strip of frames to the next. Fig. 2. Frames from a normal cinefluorographic cerebral angiogram. Fig. 4. Frames from a cinefluorographic cerebral angiogram in a patient with occlusion

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Oscar Sugar

skull roentgenogram, showing calcification in Sturge-Weber syndrome. Fig. 21. Carotid angiogram, showing (arrows) abnormal vascular tufts. (Same patient as in Fig. 20 .) Sometimes a more definite vascular anomaly is associated with the facial nevus and occipitoparietal calcification, as in Fig. 22 , taken of a child with seizures as a part of her syndrome. Fig. 22. Carotid angiogram in Sturge-Weber's syndrome, with vascular tangle. ARTERIOVENOUS MALFORMATIONS For reasons which are as yet unclear, the embryonic network

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Cerebral Angiography in Children

An Anatomoclinical Evaluation

Jorge A. Picaza

-Weber syndrome the angiograms failed to show abnormalities, and in a case of Parke-Weber congenital hemangiectasis, in which a huge angioma of the leg was well shown in angiograms of the affected extremity, the cerebral vessels were normal in spite of the fact that the patient suffered from convulsions. In another case, in which there were extensive arteriovenous malformations of the extracranial blood vessels, angiography failed to reveal intracranial abnormalities. Our material does not include studies of cerebral hemorrhage in the newborn; this deserves special

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Wallace B. Hamby

entire intracerebral vascular tree must be visualized. The 53 tests were done by injection of both carotids and a vertebral artery in only 3 cases, of both carotids in 22, of 1 carotid in 26, of a single vertebral artery in 1 case, and in 1, no successful vascular visualization was obtained. In cases in which only one carotid artery was injected, the test was made on the side suggested by the patient's clinical signs. In the 53 cases of subarachnoid hemorrhage, angiograms disclosed aneurysms in 22 cases (41 per cent) and an arteriovenous malformation in 1 case. The

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Charles E. Brackett Jr.

Arteriovenous malformations 7 0 1 14 Unverified 10 4 40 2 20 Totals 65 21 32 6 9.2 FACTORS IN THE PRODUCTION OF COMPLICATIONS Age Fig. 1 indicates that the incidence of complications does not increase with advancing age. These data are in accordance with those of Pilcher and Thuss 17 and Schorstein. 20 Furthermore, the average age according to the various locations of the aneurysms did not vary significantly so as to weight the latter figures unduly ( Table 2 ). Thus in this series age per se did not play a